9140 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ._.9._!Ico......... / (Complete in Duplicate) Date Issued Applica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. .his application is made in compliance with County Ordinance No. 549, t4c]JOB ADDRESS AND LOCATION_____ _ _ `V -------------------------------------------•.--------------••------------- ----- - Owner's Name______--W,s_________________ '�_ .---•- --- ----------------------------------------------..------------------------------------- -._. Phone.-----2 ----'-•--�-- Address------------OP-�'`7---=-`-�---4-•-- e- ----------------------••------------------------------------------------- ------------------------------------.------------------------------------- Contractor's Name -moi_./ ----- -------------------------------------------------------------------------------------- Phone ..1"----- - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ � t Number of living units: _4---- Number of bedrooms I___ Number of baths ---e... Lot size ____-P4------------ _________________ s Water Supply: Public system ER" Community system ❑ private ❑ Depth to Water Table 1,CQ_ ft. Character of soil to a depth of 3 feet: San Gravel E] Sandy Loam ❑ Clay Loam F] Clay ❑ Adobe R( Hardpan E)Previous Application Made: Yes ❑ No New Construction: Yes E+j No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (� (No septic tank or cesspool permitted if public sewer is available within 200 feet. SCJ Septic T Distance from nearest well ..._Distan e fro ff nd do ._.._? �_ri+l__ --- , [ No. of compartments__._' __________________Size: .,4E__ ___ '_. ,, Liquid depth)��..__-_-_..__.Capacity_'_ Disposal-Field: Dista e from nearest well. ---Distance from foundation---t ----------..Distance to nearest lot line_________________ f lines-----li----------------------------Length of each lin------- "�.`:.- ---------.'Width of trench--�'-_:___-------------------- pe or filter mater• �j--- --------To#al ------------- ---------- Seep Pit: Distance to near well. ____._.__Diistance from foundation---V__._.-_ __.Distance to nearest lot li �__.__. Number of pits-_ ning materidi._i"r- ----------Size: Diameter__.--.36_- Depth... ____ Cesspool: Distance from nearest )"It______________Distance frm foundation___---------,._-_-_ Lining material----------------.---------------------- Cf ElSize: Diameter----.-:`------------- v.: .Depth-------------- -------------- .. ` ----Liquid Capacity----------------------------gals. \ ,�- _Distance from nearest building-._Distance from nearest well-------------------------------------- -----_ g - ,-----------------...-------------- ❑ Distance to nearest lotlme.--- -------- ----- - --------------- - ------------------------='------------------------------------------ Remodeling and/or repairing ,;{descr.ibe):---- .----__-'�---...,---- -----------•----------------•-•--•--• -----•---------------•-----••- ---•-•--------------------------------------------------------------------•---•-------- -• --------' f --- ----••-----------------------------------------`------------—-••----------------------••-------•--•------•-•-----•-------------- ----------------------- -------------- -------.--------------------------------- --r-- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Owner and/or Contractor (Signed( ----- ------------------------ / - ;4 �r:_- )�i�_Avott-`-------- ---------------- --------- ------------------------------------(Ti+le) , (Plot plan, showing six f lot, location of system in relation to wells, buildings, etc., can be placed on revers side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- = r DATE REVIEWED BY------------------------- - - ! DATE ,. J - --------------------------------- BUILDING PERMIT ISSUED-------- - -- -------------------------------------- = DATE-------------••----•----------------------------------------- Alterations and/or recommendations---- --- ---------- ---- ------- ---- •--------•--- - -C -- ----------------------------------------------------------------------- ' -- ---- --- ------ ______________________________________________ __--------__------_-------------------------- ----------_-------___...... ----------1:...........:---------- _ ____________________________________________________ _ ____________________ A Date , -I FINAL INSPECTION BY:. ( I Date../v_ ------S. G SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9 145446 A7WP4D